You are here

Article Text

Article menu

Download PDFPDF

Original research
Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis
  1. William V Padula1,
  2. Peter J Pronovost2,3,
  3. Mary Beth F Makic4,
  4. Heidi L Wald5,
  5. Dane Moran6,
  6. Manish K Mishra7,
  7. David O Meltzer8
  1. 1 Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  3. 3 Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4 College of Nursing, University of Colorado, Aurora, Colorado, USA
  5. 5 Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  6. 6 Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
  7. 7 Community and Family Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
  8. 8 Department of Medicine, Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr William V Padula, Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; wpadula{at}jhu.edu

Abstract

Objective Hospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool nurses use daily to assess pressure-injury risk. Our objective was to analyse the cost-utility of performing repeated risk-assessment for pressure-injury prevention in all patients or high-risk groups.

Design Cost-utility analysis using Markov modelling from US societal and healthcare sector perspectives within a 1-year time horizon.

Setting Patient-level longitudinal data on 34 787 encounters from an academic hospital electronic health record (EHR) between 2011 and 2014, including daily Braden scores. Supervised machine learning simulated age-adjusted transition probabilities between risk levels and pressure injuries.

Participants Hospitalised adults with Braden scores classified into five risk levels: very high risk (6–9), high risk (10–11), moderate risk (12–14), at-risk (15–18), minimal risk (19–23).

Interventions Standard care, repeated risk assessment in all risk levels or only repeated risk assessment in high-risk strata based on machine-learning simulations.

Main outcome measures Costs (2016 $US) of pressure-injury treatment and prevention, and quality-adjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio (ICER) at $100 000/QALY willingness-to-pay. Univariate and probabilistic sensitivity analyses tested model uncertainty.

Results Simulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives, equating to ICERs of $2000/QALY and $2142/QALY, respectively. Risk-stratified follow-up in patients with Braden scores <15 dominated standard care. Prevention for all patients was cost-effective in >99% of probabilistic simulations.

Conclusion Our analysis using EHR data maintains that pressure-injury prevention for all inpatients is cost-effective. Hospitals should invest in nursing compliance with international prevention guidelines.

  • cost-effectiveness
  • nurses
  • health services research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2017-007505

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors All authors contributed equally to the development of this manuscript.

    • Funding This study was funded by Agency for Healthcare Research and Quality (grant no: 1-F32-HS023710-01).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University of Chicago Biological Sciences Division IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data for this analysis were available to all study authors. They are available to editors and reviewers on request made to WVP.